You don’t need to have a period

In light of my post on times not to tamper with the body, here’s one case where I’m very much in favor of tampering.

You don’t need to have a period.

Painful menstruation impairs daily activities for around 20% of women. That’s not including mood changes or menstrual migraines, both of which are also common. As a cause of disability, it’s not taken particularly seriously.

I was told my menstrual cramps would probably improve in my twenties. When they got worse instead, I didn’t know what to do except tough it out. My primary care provider just recommended more painkillers.

It’s a doctor’s job to warn you about the risks that come with various kinds of birth control, but we never talked about the risks I faced from unpredictable, crippling pain. Once it struck while I was babysitting two young children, and their father had to leave work to take care of them because I couldn’t stand up long enough to fix them lunch. When I worked at the jail I was in a back office having a counseling session alone with a detainee, when my skin went cold and my vision started to go dark as my body went into shock. I brought the session to a hasty conclusion, gripping the desk to keep upright, and waited until he had left to lie down on the floor until I could get up and walk. I never had to drive with bad cramps, but I can’t imagine that would be very safe.

After three and a half years of pregnancy and breastfeeding, the idea of returning to all that is not appealing at all.

Here are some ways to have fewer or no periods. This is basically the same list from actual doctors.

• Take regular birth control pills and skip the week of dummy pills at the end, starting right away on a new pack. Some sources say this is best done with monophasic pills (where the first three weeks are all the same, rather than ones where different weeks have different doses).
  There’s no medical reason for the dummy pills. When the pills were originally developed, market research indicated that women preferred to have a period as reassurance that they weren’t pregnant. Now that pregnancy tests cost less than a dollar on Amazon, there are easier ways to get that reassurance.
• Extended cycle birth control pills where you get dummy pills only every three months, or not at all. If you pay for birth control, this is cheaper than the above method because you’re not paying for dummy pills.
• IUDs. The Mirena is FDA-approved to treat heavy bleeding, it lasts 5 years, and 20% of women don’t menstruate at all after the first year. You’ll probably get more spotting for the first few months, though. Skyla and Liletta are smaller ones specifically tested for women who haven’t had a baby, though the American Congress of Obstetricians and Gynecologists consider all IUDs safe for women of all ages regardless of whether they’ve given birth. All types of IUD except the Paraguard are likely to improve menstrual cramps.
• Birth control implant. Nexplanon lasts 4 years and 20% of women don’t menstruate after the first year. Again, spotting is likely.
• Depo-Provera shots last 3 months and also cause some women to stop menstruating, again with irregular bleeding at first.
• I’ve seen some doctors say it’s ok to use the patch or NuvaRing continuously, and others say not to.

The US may be about to go back to the bad old days of no guaranteed insurance coverage for birth control, so this might be a good time to get something long-term. If you do want to get pregnant, all of these options except the shot let you return to fertility within about two weeks of stopping/removal.

There are health risks with anything you do or don’t do. Although are no known health risks of avoiding menstruation, there are no long-term studies of it. There are also no long-term studies of operating a car while in crippling pain, or of passing out in an isolated office with a random detainee, and I’d much rather use a tested contraceptive than take my chances with those.

Different methods will have different side effect profiles, so you should consider which ones you particularly care about. There are also different levels of hassle with methods that require renewing prescriptions, remembering what day to do this or that, checking that the strings are in the right place, etc.

If you’re using these for actual contraception, remember that you have a 9% chance of getting pregnant during a year of typical use with the pill, patch, or ring. Long-lasting methods work a lot better, and personally, I prefer a small risk of birth control problems over a 9% chance of either abortion or childbirth, both of which obviously come with risks as well.

If you’re not menstruating, you shouldn’t take women’s multivitamins because they have an amount of iron that’s intended for people losing blood every month. After several years, you might want to get your iron level checked.

If your period pain is really bad, get checked out for endometriosis, which is under-diagnosed. (Literally the first doctor to mention this possibility to me was the psychiatrist at work as he was helping me prop my feet on a bookshelf while I lay on my boss’s office floor after I nearly passed out in a staff meeting.)

Obviously you should talk to your health care provider about any of this. If you get a provider whose answer is basically “more painkillers,” I’d push back or get a different provider.

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Chesterton’s fence in health

[Epistemic status: mostly informed guesswork.]

I started writing down some beliefs I have about health, and realized most of them kind of echo Chesterton’s fence:

There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”
– G. K. Chesterton

In terms of health, my belief is something like: don’t mess with bodies too much, because they probably function best under conditions that existed well before the 20th century. I certainly also have beliefs that don’t fit this pattern (C-sections and formula are literally lifesavers if you need them!) A lot of these ended up being about child health, because apparently that’s what I read a lot about right now.

Specific beliefs:

Shoes 
Shoes are a pretty new development for the human body. Community Paediatrics Committee: “Children’s feet should be left alone as much as possible.”

Most modern advice is to use shoes sparingly for kids, and to use lightweight flexible shoes when needed. We’ve found that Robeez, Pediped, and See Kai Run are brands with nice bendy soles. Here’s a more complete list.

I’m not as sold on the barefoot running thing for most adults. Jeff used to have a lot of knee problems and also used to walk with a strong heel-strike, which is only viable in padded shoes. He found that walking barefoot or in minimalist shoes for a while changed the way he walked, and that combined with some other changes (stretches and exercises, not walking pigeon-toed) has resolved his knee pain. Now he’s fine in normal shoes. Unless you have a problem, I think sensible shoes for adults are probably fine.

Then there are high heels. I don’t want to do the thing where we shame women for engaging in (and enjoying) behaviors that society rewards them for doing, but I do think people (and particularly young people) should understand what heels can do to your body.

Moving throughout the day
People seem to agree that sitting down all day is bad for you. Having short movement breaks throughout the day (“nutritious movement”) might be better than working straight through and doing one longer workout. Katy Bowman‘s work on this seems 40% woo, 60% solid.

Set up your life to make this easy: wear clothes you can move in. Have a quick workout app on your phone, weights or a pull-up bar out where you see them and they’re easy to grab. Work in different positions: standing, sitting in different postures. (I realize this is much easier said than done unless you work from home, but a lot of us spend plenty of time sitting at home too.)

Use it or lose it
By the time you get old and stiff, it’s a lot harder to develop habits that improve flexibility and balance. I try to include motions that I want to be able to do throughout life: our bed is on the floor and we don’t have a baby changing table, so Jeff and I are up and down from floor-level many times a day. I can do a pretty good squat now, too. Early parenthood (after your body has recovered some from pregnancy) is a good time to work on this stuff because there’s so much bending, lifting, and getting down on the ground.

Vestibular input
Children’s vestibular (balance) systems need stimulation to develop. They need to rock, bounce, roll, tip, and spin. An overview. I think it’s likely that a lot of modern kids aren’t getting enough physical play.

Toys like swings, seesaws, rocking horses, balance beams, bicycles, hammocks, big exercise balls, jump-ropes, trampolines, office chairs, obstacle courses, tunnels, and balance boards, as well as lots of other activities, encourage motion in all different directions.

There’s some evidence that people with clinical anxiety are disproportionately likely to have vestibular problems (they literally feel off-balance and insecure!), and that balance exercises can help with anxiety.

I suspect that giving children plenty of opportunity for lots of kinds of motion helps them be more at ease, less fidgety, and better able to focus.

Posture
Back pain is really common and really debilitating. I think helping your spine be in the right shape is important, and I’m pretty sold on Esther Gohkhale’s book 8 Steps to a Pain-free Back. She draws on posture from historical images and pre-industrial societies to argue that humans are designed to stand, sit, and bend differently than we now do (though she could be cherry-picking and I would have no way of knowing).

More picture comparisons of S-shaped vs. J-shaped posture.

Reviews I’ve seen basically indicate that at worst this method is probably harmless, since it doesn’t advise special treatment or gear or doing any time-consuming exercises, just moving differently during your normal activities.

The major part of the book that I disagree with is about lifting from the back rather than the knees: I believe that people who’ve been lifting from the back all their lives can do it fine, but starting abruptly seems like a bad idea. I try to do straight-back bending while emptying the dishwasher and so forth when not bearing extra weight.

Breastfeeding
Baby formula is pretty good now (and to be clear, it’s absolutely a blessing when breastfeeding isn’t cutting it for whatever reason). There are a few randomized controlled trials of breastfeeding vs. formula feeding which indicate advantages to breastmilk, but they were from before we started putting DHA (a fatty acid thought to be good for brain development) in formula in 2002, so it’s possible they’re more similar now. But given that after 100 years of commercial formula they’re still trying to improve the recipe, I’m guessing it’s probably still not as good as the original.

Light and vision
Children who sleep with night lights are more likely to be short-sighted, and sleeping with a normal light on is worse. Apparently you need actual darkness in early childhood for your eyes to develop properlyb.

Potential confounder: maybe short-sighted parents are more likely to leave the lights on, and also more likely to have short-sighted kids. But I’d expect it to be more based on dark vision. Jeff can see ok in conditions where I can’t see at all; I do night feedings entirely by memory, touch, and echolocation (luckily it’s not that hard to find a crying baby in the dark).

Several studies also suggest that kids who spend more time outdoors are less likely to be short-sighted, maybe because of brighter light, different spectrum of light, or higher vitamin D. Could be confounded of course if short-sighted kids don’t enjoy outdoor play as much because they can’t see as well.

Gut health
In 20 years I think this will be a much more mainstream component of how we think about health.

We know that antibiotics mess up gut flora, particularly in young children.

(I was about to write that early antibiotic use makes children more prone to asthma, but apparently that’s not likely. It does seem to increase risk of food allergies, though.)

About 1/3 of mothers in the US and UK are given IV antibiotics during labor to prevent group B strep infections in their babies. Right now the reasoning seems to be that antibiotics are pretty harmless, so why not give them? But I hope we’ll develop better ways of targeting which children most need the antibiotics. In think we may also see a trend toward narrow-spectrum antibiotics for shorter periods of time.

During pregnancy and breastfeeding, I also try to be extra-careful about hand-washing, keeping cuts covered, and so forth to reduce the chance that I’ll need antibiotics. Mastitis is a common reason breastfeeding moms take antibiotics, and knowing how to deal with it before it gets bad can help avoid the need for medication.

Babies are born with a sterile intestinal tract, and they get colonized with their mother’s microflora during and after birth. There’s growing interest in how to facilitate this for babies born by cesarian section, for example by swabbing babies with fluids from the birth canal. I can imagine that this will catch on, but it might also end up being more risky than it’s worth because of group B strep, herpes, etc which you don’t want colonizing your baby.

I think water birth looks worse for this reason — you don’t want to be washing babies as soon as their born.

Right now we don’t know much about how exactly to help gut health once something is wrong, and how to add and nurture the specific microflora that you want for specific problems. The best we can do is eat fiber (prebiotics) which serves as food for the good bacteria (probiotics), and maybe eat foods with live cultures like yogurt and kimchi. These seem like a good idea, since they’re basically what people have been doing for thousands of years. Packaged commercial probiotic supplements seem generally safe, including for kids, though I think in 20 years we’ll know a lot more about which strains you want.

Plastics
I think we’ll learn things we don’t currently know about ways that plastics are bad for us. In college, before they decided BPA was bad, I used to microwave my lunch in my Nalgene bottle every day. It’s not clear that what they’re using instead is much better, we might just not have as much evidence about it. I expect it’s just a matter of time until they find long-term effects from things we haven’t been using very long. I don’t put hot food in plastic containers anymore. We use Pyrex glass containers for most food.